The effect of therapy on arousal from sleep in patients with respiratory sleep disorders
File(s)
Author(s)
Alqarni, Abdullah Saad
Type
Thesis
Abstract
Vibrotactile positional therapy (PT) is a relatively new treatment for positional obstructive sleep apnoea (POSA). It uses vibrotactile stimulus to encourage the sleeper to change position when supine. The overall aim of this thesis was to investigate the efficacy of vibrotactile PT as a clinical treatment for patients with POSA. To achieve this, different experimental approaches were used, including a systematic review and meta-analysis, a clinical trial, and a physiological study.
The systematic review was carried out to evaluate the effect of vibrotactile PT on apnoea hypopnoea index (AHI), percentage of time spent in supine (%Tsupine), and patient-centred outcomes in patients with POSA compared to baseline. The results showed that vibrotactile PT was effective in reducing both AHI and %Tsupine. Although the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire minimally improved, these changes did not reach clinically important differences; however, limited data were found on quality of life (SF-36) vitality score.
A prospective, three-month, multicentre, randomised, parallel, double-blind trial (The POSA Trial, ISRCTN51740863) was developed to investigate the effect of vibrotactile PT on AHI, quality of life and daytime functioning at follow-up, adjusted for the baseline, in patients with POSA compared to sham-vibrotactile PT. Baseline data (AHI, quality of life and daytime functioning) obtained from the participants recruited at the Royal Brompton Hospital are presented in the thesis. The mean baseline AHI for RBH participants was in the mild OSA category compared to the patients in the systematic review; however, a higher baseline %Tsupine was found. The baseline patient-centred outcomes were also comparable to those found in the systematic review.
A physiological study in healthy participants (n=27) was carried out to investigate the effect of vibrotactile stimulus on arousability from sleep. A novel analysis method was developed to measure arousability. This included the duration from the vibrotactile stimulus to the position change using polysomnography. The results of this study showed heterogenous arousability responses to the vibrotactile stimulus with different phenotypes. Compared to males, healthy females took longer to respond to the vibrotactile stimulus and, therefore, were more resilient to arousability.
In summary, the findings of this thesis have shown that vibrotactile PT devices are effective in treating patients with POSA. However, limited data on sensitive patient-centred outcomes exist. The POSA trial will provide data to address this evidence gap. Furthermore, the physiological findings in people without OSA showed that males are more arousable than females. This information may be of value when considering personalisation of clinical treatment. Future research of POSA will need to consider the arousability phenotype when planning treatment options.
The systematic review was carried out to evaluate the effect of vibrotactile PT on apnoea hypopnoea index (AHI), percentage of time spent in supine (%Tsupine), and patient-centred outcomes in patients with POSA compared to baseline. The results showed that vibrotactile PT was effective in reducing both AHI and %Tsupine. Although the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire minimally improved, these changes did not reach clinically important differences; however, limited data were found on quality of life (SF-36) vitality score.
A prospective, three-month, multicentre, randomised, parallel, double-blind trial (The POSA Trial, ISRCTN51740863) was developed to investigate the effect of vibrotactile PT on AHI, quality of life and daytime functioning at follow-up, adjusted for the baseline, in patients with POSA compared to sham-vibrotactile PT. Baseline data (AHI, quality of life and daytime functioning) obtained from the participants recruited at the Royal Brompton Hospital are presented in the thesis. The mean baseline AHI for RBH participants was in the mild OSA category compared to the patients in the systematic review; however, a higher baseline %Tsupine was found. The baseline patient-centred outcomes were also comparable to those found in the systematic review.
A physiological study in healthy participants (n=27) was carried out to investigate the effect of vibrotactile stimulus on arousability from sleep. A novel analysis method was developed to measure arousability. This included the duration from the vibrotactile stimulus to the position change using polysomnography. The results of this study showed heterogenous arousability responses to the vibrotactile stimulus with different phenotypes. Compared to males, healthy females took longer to respond to the vibrotactile stimulus and, therefore, were more resilient to arousability.
In summary, the findings of this thesis have shown that vibrotactile PT devices are effective in treating patients with POSA. However, limited data on sensitive patient-centred outcomes exist. The POSA trial will provide data to address this evidence gap. Furthermore, the physiological findings in people without OSA showed that males are more arousable than females. This information may be of value when considering personalisation of clinical treatment. Future research of POSA will need to consider the arousability phenotype when planning treatment options.
Version
Open Access
Date Issued
2022-01
Date Awarded
2022-03
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Morrell, Mary
Kelly, Julia
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)